The bible of psychiatric diagnosis exempts religion from “delusions”, even though it is one

I’ve just finished reading a prepublication copy of Peter Boghossian’s book A Manual for Creating Atheists, which will be published by Pitchstone on November 1. I recommend it highly, as it’s quite different from other atheist books. Rather than going through the usual arguments against God and showing that religion is harmful and delusional, he takes these issues as givens and then tells the reader how to change other people’s minds, dispelling their faith. He tries to turn the reader into what he calls a “street epistemologist,” skilled at arguing against religious beliefs in a way that will actually work. His techniques are based on decades of experience in the classroom (he’s a philosopher who teaches courses in critical thinking and atheism at Portland state), in working with prisoners, and in one-on-one encounters with the faithful.

What I also like about the book is that he concentrates not on religion per se, but on the idea of faith as a failed epistemology. He thinks (and I agree) that our greatest leverage against religion is its reliance on “faith”—belief without good evidence—as a “way of knowing,” a way that is simply not justifiable to a rational person. One of our best weapons against religion is simply to ask its adherents, “How do you know that?” And so Boghossian’s strategies are concentrated on going after faith, and not letting yourself get distracted by issues like the so-called beneficial effect of religion on morality.

So have a look at Peter’s book (he gave a terrific talk on it in June at TAM). What I wanted to post, beyond this recommendation, was something in the book that I didn’t know. The DSM of psychiatry, explained in the excerpt below, defines delusions in such a way that religion is really one of them. But then it exempts religion from the psychiatric diagnosis of “delusion” because it is widely held. Here’s an excerpt from Peter’s book, which I post with his permission (the bolding is Peter’s, but I would have bolded it, too!):

The Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association (APA), is the single most important text used by clinicians. It is the diagnostic rulebook. Currently, the DSM grants religious delusions an exemption from classification as a mental illness. The following is the DSM-IV’s definition of delusion:

“A false belief based on incorrect inference about external reality that is firmly sustained despite what almost everyone else believes and despite what constitutes incontrovertible and obvious proof or evidence to the contrary. The belief is not one ordinarily accepted by other membersof the person’s culture or subculture (e.g. it is not an article of religiousfaith). When a false belief involves a value judgment, it is regarded as a delusion only when the judgment is so extreme as to defy credibility. Delusional conviction occurs on a continuum and can sometimes be inferred from an individual’s behavior. It is often difficult to distinguish between a delusion and an overvalued idea (in which case the individual has an unreasonable belief or idea but does not hold it as firmly as is the case with a delusion)” (2000, p. 765).

Again, religion gets a pass in society. Why should someone’s belief be a delusion only if it’s held by a minority of people? In the important respect of being “an incorrect inference about external reality that is firmly sustained,” and one that “defies credibility,” religion is a delusion. But note how religious faith is specifically exempted. Further, many individuals’ religious behaviors do indicate a delusional conviction (falling on one’s knees and talking to an imaginary friend, eating wafers, bowing toward Mecca five times a day, and so on).

Richard Dawkins’s book was properly named The God Delusion, although of course that angered the faithful, who don’t want to be seen as delusional. If 80% of the population suddenly became schizophrenic, would that no longer be seen as a mental disorder because it’s common?

What is important, I think, is not the frequency of a “disorder”—whether it deviates from the “norm”—but whether it inhibits one’s well-being or leads to behaviors that interrupt one’s life and rest on distorted views of reality (e.g., obsessive-compulsive disorder). The fact is that if, say, evangelical Christianity were the sole religion in the world, and was seen in only 2% of the population, the DSM would classify it as a delusional disorder.

Having practiced Aikido for many years, I don’t know who this teacher is. I doubt he’s affiliated with any major Aikido school, and I don’t recognize his style. Also, no Aikido teacher would wear a gi like that… so whatever it is, Aikido it ain’t.

Pete uses these same two video clips in his critical thinking class. He also studies BJJ and has done so for several years at least. He takes a dim view of any martial art that does not have grappling with active resistance as its primary focus. Pete’s lectures are highly entertaining. Most of his classes are meant to be entry level, so he moves at a fairly pedestrian pace (this may be so that any religious students can follow). Being a follower of this website, most of his critical thinking class was review, but still fun.

Well, St. Joan was ‘institutionalized’–but years after her death at the stake for heresy. Seems that a later pope saw a martyr-saint where the previous administration had vilified her as a heretic. First, too much god: death; then, lots of god, can’t have too much: sainthood. That’s institutionalization, Roman Catholic style!

” then tells the reader how to change other people’s minds, dispelling their faith. He tries to turn the reader into what he calls a “street epistemologist,” skilled at arguing against religious beliefs in a way that will actually work. ”

I’ve seen some research showing that people are more susceptible to influence when you start with reaffirming their core values. Now, that might be difficult to do when it comes to the idea of religion itself, but it might be possible to move people away from the more radical positions.

I’ve been saying for years that religious people are delusional and receive a pass from the psychiatric community. That’s because most of the psychiatric community buys into religion and they don’t want to label themselves as delusional. Psychiatric community loves labels. They can provide a label for almost every behavior and for the most part these labels indicate dysfunction. My entire life is dysfunctional, but it works for me. But the religious — no dysfunction there, is there?

That’s because most of the psychiatric community buys into religion and they don’t want to label themselves as delusional.

And who wants to get into trouble with the majority? We may not burn people at the stake anymore, but other than that I think quite a few people reading and responding here know too well what happens whe you start denying the religion of the people around you. So, I guess it’s self-preservation.

The purpose of the DSM is largely to identify people who have difficulty living in society due to some clinical mental disturbance. If you live in a society where everyone believes the same delusion, you probably will get along pretty well.

In other words, it probably doesn’t make much sense to say that almost all of humanity suffered from a mental disorder until the Enlightenment.

If a delusion is widely shared then it should be treated instead as a human condition, rather than as an individual pathology.

This ties into the consciousness raising some people are doing about “othering”. When we describe murderers, rapists, gang members, Nazis and others as “monsters” or as “subhumans”, then we are tacitly denying that we could act in a similar way, given similar conditions. Getting back to religion, I think there may be some base rate of atheists in a population but as we see in different cultures, there are a lot more people that can grow up to be either religious or atheists depending on their upbringing. If these individuals (and how do we know that we aren’t one of them?) did become religious, they are doing so because of some traits that are widely shared.

gbjames – If we found a literal parasite that was a major contributor to religious belief then sure.

But otherwise, no. Most humans are predisposed to various illusions, cognitive distortions and biases (eg: racism) because of how our brain works. These might be detrimental, but they aren’t pathologies, they’re part of being human.

My point wasn’t that there are parasites responsible for religious belief, although I’m willing to entertain that possibility. I was trying to push back at the idea that the percentage of people affected by something bad is what determines if that something something is a pathology or just “the human condition”.

Here is the latest definition I’ve grabbed from a SECONDARY reliable source:-

“Delusions are fixed beliefs that are not amenable to change in light of conflicting evidence. Their content may include a variety of themes (e.g., persecutory, referential, somatic, religious, grandiose). Persecutory delusions (i.e., the belief that one is going to be harmed, harassed, and so forth by an individual, organization, or other group) are most common. Referential delusions (i.e., belief that certain gestures, comments, environmental cues, and so forth are directed at oneself) are also common. Grandiose delusions (i.e., when an individual believes that he or she has exceptional abilities, wealth, or fame) and erotomanic delusions (i.e., when an individual believes falsely that another person is in love with him or her) are also seen. Nihilistic delusions involve the conviction that a major catastrophe will occur, and somatic delusions focus on preoccupations regarding health and organ function.

Delusions are deemed bizarre if they are clearly implausible and and not understandable to same-culture peers and do not derive from ordinary life experiences. An example of a bizarre delusion is the belief that an outside force has removed his or her internal organs and replaced them with someone else’s organs without leaving any wounds or scars. An example of a non-bizarre delusion is the belief that one is under surveillance by the police, despite a lack of convincing evidence. Delusions that express a loss of control over mind or body are generally considered to be bizarre; these include the belief that one’s thoughts have been “removed” by some outside force (thought withdrawal), that alien thoughts have been put into one’s mind (thought insertion), or that one’s body or actions are being acted on or manipulated by some outside force (delusions of control). The distinction between a delusion and a strongly held idea is sometimes difficult to make and depends in part on the degree of conviction with which the belief is held despite clear or reasonable contradictory evidence regarding its veracity”

The gospels, I think, predict that Christians will be persecuted (and the theme is repeated in the rest of the New Testament) and, together with Revelation, also predict a catastrophic end to the world. Such convictions, plus that of One who can read our minds and has a particular purpose for each of us, are ordinary assumptions for the average Christian.

Theologists may hold the “bizarre” belief that God puts the idea of God in our minds, or even our morality (the Eden myth notwithstanding), but most people don’t actually seem to believe this.

Psychiatric examples of delusions tend to be self-generated. For example, If I believe UFOs are trying to beam messages to me through my cat. Religion is something one is usually taught or otherwise indoctrinated into. It may be that somebody is willingly buying into an odd worldview, but that does not mean it meets the clinical criteria of delusion that indicates a psychiatric condition that merits treatment.

It would be fair to make a distinction based on population and majority opinion.

I’m no psychiatrist, but there’s probably some meaningful psychological difference between the madman and the average religious person.

Take the man who believes, despite everyone else saying otherwise, that he has an invisible rabbit friend.

Compare him to the man who believes that he has an invisible wizard friend, because he has been told this ever since childhood by people who he trusts as authorities and whose other claims about reality have proven true as well.

The second is a failing of the human brain to understand what constitutes a good basis for a claim, but is likely different from un-shared false beliefs.

As such, I can see why religion (in general) doesn’t warrant categorization as a delusion. At least potentially. However, there should be some other classification for clearly contradictory beliefs, such as a perfectly good diety who tortures most of humanity for eternity. Now, if that isn’t worth a page in a psychology handbook, then it’s a clear case of religious exemption.

No truly religious person cares a tinker’s damn about proving the existence of deities, any more than traditional Aboriginal people cared about the biological explanation of birth; it is not the question they are asking or the answer they have found.

Making sense of life, and what to do is not the domain of science. There is no subjective existence in science it abhors that point of view and it cannot answer that deeply personal desire. Poetry, literature, the arts in general and religion as a peculiar art those things can be harnessed and are harnessed by millions and millions of people everyday — both by atheist and theist.

Is religion here to explain the world, or make sense of living within it? The two are nowhere the same. Pretending that they are is a disgraceful betrayal of reasoned thought and I might add science itself.

I won’t argue about what a truly religious person might care about. Or a truly Scottish person either.

What I will argue with is your contention that reason and science are disgraced by helping us “make sense of life”. They have contributed enormously to my personal sense of life. Way more than looking at a Picasso painting or listening to Verdi’s Requiem ever have. (Much though I love those kinds of art.)

Everyone comes up with ideas that don’t match reality. For instance, I have one of those barbecue aprons with a cartoon on the front that I keep hanging on the kitchen door. Last week it seemed like every time I turned around I would get a glimpse of the face and I’d think my son was standing there.

Where the psychosis comes in is when you cannot pull in other evidence to make good judgements about whether the idea is true or false. I was capable of looking again and realizing that I had just seen a cartoon character, and not my son. If I lacked the capacity to connect that original idea back to the real-world evidence, then the idea would have persisted as a delusion.

The problem with labeling religious people as having a psychosis is that their minds do go through the process of weighing new ideas against outside evidence. They just have a lot of outside evidence that isn’t quite factual — e.g. the Bible, sermons, Sunday school lessons, the beliefs of their family and friends, etc. The firmware of their brain works fine, but the data is crap.

Epistemology is the most important aspect of being an atheist. Citing moral reasons or cherry picking historical events that outline the caustic nature of religion or referencing specific prejudices or mentioning any atrocity in the name of religious faith….these are like bird watching, fun but not very useful if one’s intention is to remove the disorder that is faith.

All religions are esoteric and arbitrary. What one knows or perceives as truth is fundamental to existence; this is good street epistemology. Hopefully Boghossian’s book will be available in audio.

If we’re adding religion to the list of delusions, I hereby nominate every retail manager I’ve ever had for telling me that I could work my way up the ranks and be President of the company one day, and every minimum-wage earning co-worker of mine who ate that sh*t up. Capitalists are delusional, and so are socialists and democrats and republicans and anyone who thinks a species of identically-minded beings has a spitting chance at long-term survival.

As a lifelong atheist, was I wrong to go along with the Santa Claus, Easter Bunny and Tooth Fairy “delusions” at the age-appropriate time in my children’s lives, or did it teach them a valuable lesson about the susceptibility to myth and superstition and the importance of questioning?

It is debatable whether religion is a delusion or a natural result of propensity to give into common shared cognitive illusions, I’m torn between these two possibilities. I agree that popularity of the “delusion” definitely does come into play on whether something is considered a disorder. Another factor could be fear of reprisal from funding sources, should religion be declared either a delusion or the product of falling for common cognitive illusions. That is an unfortunate political reality that always has to be kept in mind.

No, but it some ways of looking at it they are not quite the same. Contrast Dawkins God Delusion with the approach taken by Pascal Boyer or Scott Atran. Perhaps there is a harmonic convergence in the end.

I think what concerns Dawkins and what concerns Boyer/Atran are different issues, at least that’s my read of those three. Boyer and Atran are attempting to make an analysis that explains religion whereas Dawkins is more concerned about the affects of religion and the “truth value” of religion (I mean, lack thereof).

Good points. Boyer, Atran and others are trying to explore the evolutionary underpinnings of religion – what makes us humans susceptible to religion in cognitive biases etc., while Dawkins, Harris etc look at how the particular major instantiations of religion in the west – Islam, Christianity -effectively are delusions from the standpoint of evidence and as analogous to other delusions such as those suffering from mental illnesses or many other delusions such as alien abductions, homeopathy, etc. These delusions may have underpinnings in our susceptibilities to them, which unfortunately currently only a small minority of people seem to have developed a full immunity to their effects.

It can be taken as a more or less “fact” that people reading this bl*g are atheists. At age 76+ I have been an atheist for longer than most (at least 60 years). I have also been an anthropologist and do not know of a single culture, past or present, which is atheistic. The comment about 80% of a population being schizophrenic and religion as being delusional completely overlooks the fact that humans have and have had some form of religion for as long as there have been modern humans (as far as archaeology can tell).

The least complex cultures like the !Kung of southern Africa (hunted almost to extinction by the civilized Dutch who settled there) have religious beliefs which are hardly complex and their religious ceremonies are essentially nonexistent (see Richard Lee’s really fine books on their culture). Richard lee is and has been a Marxist and writes as much in his detailed ethnography which I consider one of the finest of the last half of the 20th century. More complex cultures such as exist among people living in larger groups in villages (equestrian nomads come way later – in historic or very late prehistoric times) have more complex societies and more complex and shared belief systems. It’s right there in the archaeological record. More complex societies require shared belief systems and atheism is a far more modern belief system. Religion may be seen as delusional by a minority of the well educated of the past few centuries, but it is a recent development. Science, in a sense, made it possible by providing alternative explanations which some people found acceptable and others not. Calling it delusional is simple name-calling. As evolutionists, especially Dawkinsonian evolutionists (I used The Selfish Gene and the Blind Watchmaker in several of my classes), one has to consider the implications of memes and their expression in various cultures. Selection works on memes as well. Over time more useful beliefs tend to replace less useful. The flat Earthers who were totally convinced that the sun went around the earth are nearly extinct. On the other hand the climate-change deniers will probably give up their beliefs only when a few million people die as a result of oceans floding the coasts and various other disasters. The Catholic church may have accepted Darwin more than a hundred years ago but dozens of my students educated in Catholic schools were not aware of that. As for Catholic views on population control? Who knows what it will take to change that set of memes. Nine billion people? Half of them starving?

Religion is not delusional – dysfunctional at times yes – like an appendix. Religion is the norm. Looked at by “anthropologists” from some other life system atheism would seem to be the delusional belief system of Earth’s cultures.

I live in Iowa. Our governor (Branstad) has packed as many committees as possible with right-wing christians. Don’t think for a moment that that doesn’t keep me incensed. I sure as hell didn’t vote for him. But religion lives on. useful to many – a curse to others. In this country, at this time, it is a curse to me. Another anthropologist who converted to postmodernism wrote, in his more rational years, about “cultural devolution.” We are trapped in one of those moments in evolutionary time.

You have a few years on me but I, too, was once an Anthropologist. (Now a member of Anthropologists Anonymous 😉 So I’m also well aware of the ubiquity of religious belief across cultures and over time.

Still, I take delusion to mean “beliefs held strongly despite strong evidence to the contrary”, which is pretty much the Wikipedia version of the term. If one loads it up with modifiers like “idiosyncratic” then, sure, you can shift it into a position where it no longer applies to religious faith. I don’t find much value in that approach, though. For me the most important aspect of the word is the “against strong evidence” part. So I think it is very much delusional, despite its commonality.

I’d offer to swap governors with you (mine is Walker) but I’m not sure which of us would get a worse deal.

The against strong evidence part is what makes me see religion as no different from other delusions as well. It’s close to OCD except with OCD you realize the rituals are probably silly but you can’t help yourself because of an overwhelming compulsion that if the ritual is not performed, something bad will happen. Religion, to me, is ritualized OCD.

“The belief is not one ordinarily accepted by other members of the person’s culture or subculture (e.g. it is not an article of religious faith)”

Notice that the quote specifies “the person’s culture or subculture”, not simply “other people”. No religion is accepted by a majority of people and so, if one instead substituted “not one ordinarily accepted by other people”, then specific religious beliefs are indeed delusions. Notice also that the quote states “culture OR subculture”. Does this not mean that the member of the Jim Jones cult that committed mass suicide were not delusional because everyone in their “subculture” believed?

I’m looking forward to reading Peter Boghossian’s book. I really enjoyed his TAM talk too.
As to the new DSM, I think it’s appropriate to exclude religious belief in this limited context. The purpose of the DSM criteria is to identify mental illness. A general belief in a supernatural being is not indicative of a disorder and so would not aid in diagnosing an individual. It would perhaps be correct to say that this particular delusion is not salient when making a mental health diagnosis.

Except in extreme cases, I think it’s problematic to classify religious belief as a clinical mental disorder. But we can still justifiably call it a delusion in the more general sense of the word as a strong belief held on insufficient evidence or despite conflicting evidence. Religious belief seems to be the result of various kinds of cognitive bias to which human beings are prone. So it’s a common and persistent error, but not necessarily a mental illness.

It may be a question of what is cause and what is effect. I think some forms of religiosity certainly !*cause*! or !*instigate*! mental imbalance, but it is not clear that they are !*caused BY*! mental imbalance.
Private delusions are more likely in the latter category.

Talking about whether or not “religion” counts as a delusional disorder is complicated by the specifics of both the religion and the individual involved. If you meet a new acquaintance who tells you she believes that the Earth is inhabited by spirits of aliens who control our thoughts and emotions and that it is very important to take active steps to rid yourself (and the world) of these spirits…and goes on to explain that the trouble all began when an intergalactic overlord named Xenu filled the Earth’s volcanoes with nuclear weapons, blah blah blah…If you were unfamiliar with Scientology, you would think this person is obviously mentally ill. If you recognized that she’s talking about Scientology and audits and E-meters, etc, you would probably conclude that she is ridiculously ignorant, gullible, stupid, etc, but you would be much less likely to recommend a psychiatric evaluation.

Similarly, if your new “friend” tell you he believes that there are good and evil spirits all around us and they can help or hurt us in our daily lives if we look for them, etc. and the reason for this state of affairs has to do with a talking snake and a magical piece of fruit…Again, out of context we’d be ready to prescribe an anti-psychotic medication.

The real psychiatric issue is not specifically “delusional disorder” or psychosis, but a spectrum of personality traits and disorders like schizotypal disorder which can involve profoundly magical thinking and paranormal beliefs. When people with these personality traits get religious, they end up handling snakes, etc. When well adjusted, psychologically stable cling to religion, they talk about metaphors and the golden rule. And there’s a whole range of intermediates as well.

IMHO we are missing a critical outcome of the current DSM approach: the acceptability of a religious delusion is based on the prevailing delusions in that culture. This would justify a society dominated by, say, Christians, to decide that Atheists are operating under a delusion and requiring treatment (and the reverse). This is a scary form of the tyranny of the majority that we have seen played out in various religious states over time.

That seems to assume that the basic processes that are consistent and testable and repeatable, that is, reality; is equal to opinions or beliefs that are not supported by the evidence of those basic processes.

If the clock of human knowledge were turned back to a time when the basic natural processes weren’t known or understood, then it was conceptually possible that the christian ideas could have turned out to be correct. As human knowledge of basic natural processes has illuminated what is actually happening, it turns out that an atheistic view is far more consistent with reality. There isn’t any solidly grounded way to chose christianity, in any of its forms, and then also be consistent with reality as it is known to function. For, even if they construct an extremely deceptive and manipulative god it cannot have existed as a first cause.

It certainly is possible for a group of humans to construct laws that state that reality is illegal but, that group of humans will be in serious jeopardy of failure.

In the late 1950s, three men who identified as the Son of God were forced to live together in a mental hospital. What happened?

By Vaughan Bell
Updated Wednesday, May 26, 2010, at 11:59 AM

In the late 1950s, psychologist Milton Rokeach was gripped by an eccentric plan. He gathered three psychiatric patients, each with the delusion that they were Jesus Christ, to live together for two years in Ypsilanti State Hospital to see if their beliefs would change. The early meetings were stormy. “You oughta worship me, I’ll tell you that!” one of the Christs yelled. “I will not worship you! You’re a creature! You better live your own life and wake up to the facts!” another snapped back. “No two men are Jesus Christs. … I am the Good Lord!” the third interjected, barely concealing his anger.

Frustrated by psychology’s focus on what he considered to be peripheral beliefs, like political opinions and social attitudes, Rokeach wanted to probe the limits of identity. He had been intrigued by stories of Secret Service agents who felt they had lost contact with their original identities, and wondered if a man’s sense of self might be challenged in a controlled setting. Unusually for a psychologist, he found his answer in the Bible. There is only one Son of God, says the good book, so anyone who believed himself to be Jesus would suffer a psychological affront by the very existence of another like him. This was the revelation that led Rokeach to orchestrate his meeting of the Messiahs and document their encounter in the extraordinary (and out-of-print) book from 1964, The Three Christs of Ypsilanti.

I’m sick of seeing atheists run away when the pious attack reason. For example, I’ve never seen an atheist who’s willing and able to fight back against the insane but quite popular Presuppositional Apologetics.http://goo.gl/WWLPD

Religion vs. atheism is full of epistemological issues–usually used to the advantage of religion and avoided like crazy by atheists. Maybe this book will be a welcome shift toward recognition by atheists of the importance of epistemology.

One attack on reason used by the pious is this: a theologian will write something like “The atheists say we must have reasons for our claims, but what are the reasons for THAT? There aren’t any!” Be aware that the writer has, in the minds of his pious readers, blown away the chief argument of atheists–the pious don’t need reasons for their beliefs and the atheists can be seen as ignorant.

I think a good point to make about religious faith is that, if it were epistemologically valid, all religious ideas would be true, including those of the Islamic terrorists.

Denial by itself won’t do – it is at a too high energy state and is unstable. (You cannot keep saying no, no, no, it can’t didn’t happen. The tension is released by an elaboration. The elaboration for a story telling animal is called transcendence.

Death is denied. Corporality (what dies) is denied. (Ergo VIRGIN BIRTH). Generation(s) are denied. God and son, two generations, are conflated as one (!)

If generations are denied (transcended) then DEGENERATION is overcome (transcended)).

Ghosts represent death, but not if their holy (or friendly, as Caspar) and their holiness allows them to partake in the rebirth/transcendence.

The entire psychological anatomy has been so fined tuned — ever since some Australopithecine (?) was aware enough – self aware

Some highly constrained “immortality ideologies” and their psychological defenses ARE allowed. As long as their holders are OTHERWISE mental well – AND not like the cases in Ypsilanti (and the other such cases – see Slate Magazine article).

And their IS an accepted (wink wink) exclusion alternative/criteria.

For wink wink, read religion

Only those delusions that fall under the accepted religion, and for which A RATIONAL has been given and accepted.

I have always thought it ridiculous that religion gets a free pass. From my point of view believing and then acting upon that belief, in something no one can provide solid evidence for, is a delusion.

Exemptions due to cultural preferences should be reviewed.

Let’s say a guy, lets call him Joe, thinks there are leprechauns in his yard, is he delusional? Maybe, I am not sure a tenuous belief is quite yet a delusion, but when Joe starts acting on those beliefs, say looking for them in the garden, and telling his pals at the bar about them, now it is definitely a delusion. So lets say Joe happens to be Irish. Leprechauns are Irish traditionally, so Joe gets a free pass due to his culture? I don’t think so, not in my book.

I’m a medical student going into psychiatry and very active atheist. At first I found this “free pass” frustrating as well as a kind of cop-out.

But DSM is in no way making arguments about the truth of delusional beliefs. What it’s really getting at is this: imagine two people. Both believe there’s a statue in the middle of their town that is a living god which cries tears of milk (but not literal milk; you have to have faith to see it). One of them lives in a town in India where 500,000 other people believe this, and he’s been told from birth by everyone he’s ever met that this is true. The other one lives in Kansas City and he’s the only one who believes it, despite exasperated friends and family trying to reason with him. These are two very different kinds of people, and while they’re equally wrong, the guy in Kansas City is more likely to have something pathologically wrong with his cognition. To erase this distinction is to say that ALL humans are delusional; since all of us certainly have false beliefs, many of which are propagated culturally (like the milk-tear god) and will later be found out to be false, like modern-day Flat-Earth equivalent beliefs.

If you’re concerned that DSM over-pathologizes human behavior, then I think for over-pathologizing you couldn’t do better than calling all incorrect beliefs illnesses.

DSM is not trying to be an arbiter of truth, it’s trying to usefully categorize illness for practical purposes of treatment. In point of fact DSM-V clarifies that the delusion *doesn’t even have to be false* if the person holds the belief regardless of conflicting evidence and for no good reason. (Which a rationalist should agree with!)

I get your distinction yet that religion disclaimer still bothers me. I’d prefer that they just remove it as having it there appears to be a bit of an overreach and puts the DSM a little closer to being “arbiter of truth” vs. “guide”.

I am a psychiatrist and neuroscientist and atheist of long standing, so I have considerable experience with the issue of delusional and non-delusional religious belief. Let me give an example. I’ve changed a lot of the details, so that there is no chance that any of these folks could be identified.

A 35 year old woman was admitted to the psychiatry ward, partly because her obstetrician was worried that she was refusing treatment for gestational diabetes and insisting that she deliver her second child vaginally despite having a previous c-section. This is a potentially lethal combination, as gestational diabetes makes big babies and previous c-sections make uterine rupture, which can result in the death of mom and baby, more likely.

This woman explained to me that she was the founding member of the ‘Flying Saucer Church’ and that she communicated regularly with aliens who, among other things, had taken her to the other world, removed the scar on her uterus and were giving her ‘god’s insulin’ so that she no longer had diabetes. She identified several signs that I was the spawn of Satan (my blue shirt, beard and tie covered with satanic symbols [paisleys, it was a while ago]).

The next day, several people, including her husband, came to visit her. They all identified themselves as members of the Flying Saucer Church and identified the patient as he church’s prophetess. None of them received ‘revelations’ from the aliens, but they all expressed belief that these beings were real.

My patient was mentally ill (probably suffering from schizophrenia) and experienced auditory hallucinations and referential ideas. Her delusional beliefs were rather bizarre explanations for perceptual distortions that occurred because her brain misattributed salience to otherwise neutral percepts (e.g., my paisley tie). Her followers were wrong (there were no aliens) but not delusional. That is, their false belief stemmed from cognitive errors, gullibility or other problems, but their brains worked more or less normally. We treated the patient with antipsychotics and she stopped hearing voices and having referential ideas. Her followers were left to figure out what that meant, but presumably they were as able as any believer to determine the falseness of their belief.

The distinction between false beliefs due to a brain disease and false beliefs due to cultural bias (the patient’s congregation was just a bit different [and considerably more polite] than the folks who scream and speak in tongues) is useful. People with brain diseases that cause psychosis usually need drugs, while people who are wrong are best approached with persuasion.

Religion does not get a privileged pass in the DSM. Belief in homeopathy or astrology or ESP would also not automatically be deemed delusional if, as is the case in this country, there are large numbers of people who accept the phenomena as facts. Religious belief is is simply a the best example of a belief that is wrong, but not automatically evidence of a brain disease. Religious believers almost (but not quite) always readily differentiate between their co-religionists who are psychotic and those who are not, because the form and content of their expressed beliefs (and other behavior) are different from the local norm.

For example, it’s relatively common for mentally ill Moroccans to claim to be possessed by djinni or to hear the voice of allah. Many Moroccans would agree that demonic possession and deific communication are both possible. And yet these folks are almost universally recognized to be ill, partly because these beliefs are part of a syndrome that includes other behavioral aberrations.

It’s important to be able to differentiate between people who are wrong and people who are psychotic.

The greatest teacher is the ‘History of Ideas’, and it is a shocker ! It might be difficult to accept that for all of human history, almost everyone believed in a collection of crackpot theories about themselves and the world around them. If you haven’t done so, read up on the ‘Four Humours Theory (4HT) of human bodily function, which ran for 2300 years. The best known part of it was leeching. That ‘theory’ prevailed until fifty years before the birth of my father, and here in France, leeching was still practiced in the 1950s. In the Baltic States there is a Russian doctor who still apply leeches.
How about the ‘theory’ that women are intellectually inferior, which has run forever and still grips two thirds of the world’s people? My former television production studio had a training program, which attracted mostly gay women who were brilliant at it. The men recruited wanted to play the heroic director, and did a lot of posing, while the gay-gals went on expeditions to Africa to get film on the rights of women with which to make programs.
I feel that academia has always shown a reluctance to tackle the real history of ideas because it impugns all subjects, all of the time. And it also shows that the ‘accumulation theory’ of human knowledge is a not starter. And it does turn one into an awful sceptic.
Finally, watch-out for the Social Sciences, which are all without intellectual foundation. Sociology and Psychology are based upon a glaring misunderstanding of the social mix. Their core beliefs seem to have a half-life of about 50 years, and they curiously parallel the religions in having similar ‘social mechanisms’ with which to keep their beliefs in place, such as Social Self-Selection, and constant ‘tests’ to remove dissenters.
In the light of the ‘History of Ideas’ I don’t think that you can restrict ‘delusional’ only to minority beliefs.

It seems to me that this is also the way of dealing with creationists. Rather than countering arguments with evidence and going round in circles, deal with them as a good teacher does with a student and ask questions to direct them to the evidence and expose the folly of their thinking. People will only reject a previous model of the world which they hold (and which are often very securely held) unless they have thought themselves out of a conundrum. There is a teaching scheme called CASE (Cognitive Acceleration through Science Education) here in the UK which centres around the concept of cognitive conflict. The idea is that students will be exposed to a situation that conflicts with their current understanding of the world (a ‘somewhat surprising’ event)which they have to then think themselves out of. I am a fan.

Consider the following three cases that come into a psychiatrist’s office:
(1) A guy believes that the Angel Gabriel came to him in a cave and gave him a revelation. Later, he is flown to Jerusalem on a winged horse and then up through the 7 heavens to talk with God and the prophets. Is he (Mohamed) delusional or not?
(2) A guy believes that the Angel Morani has given him a revelation written in Egyptian hieroglyphics on golden tablets, which he translated using magical stones. Is he (Joseph Smith) or not?
Either we have to conclude that pretty much every religion was born of a mental illness or else change the psychiatric definition of delusion. I understand the difference between believing crazy things because one is taught to believe it versus believing from personal experience but this can only mean that “revelation” is a form of mental illness.

But isn’t revelation a form of mental illness? If either Mohammad or Joseph Smith presented themselves for psychiatric evaluation in today’s society, they would not be lauded as the founder of some great new world religion. They would be diagnosed with some form of mental illness and most likely medicated. I’m not a psychiatric professional, just an ordinary person.

Joseph Smith was a con-man and he flat out made up all the stuff in the B of M.

I don’t know about Muhammad because he is just barely an historical figure.

Jeanne d’Arc was almost certainly mentally ill, as the contemporary description of her behavior and reports of voices is fairly consistent with someone suffering from mania (although schizophrenia is also possible or a host of less probable secondary psychotic disorders).

L. Ron Hubbard clearly made up most of the scientology nonsense, although he seems to have joined his own cult later in life. He was at least narcissistic enough to believe in his own prowess as a ‘therapist’, even if he didn’t really believe some of the more bizarre back story he’d created.

Some folks who get communications from deities are psychotic.

Some are just lying.

Some probably get so worked up emotionally that they misinterpret their arousal as a visitation by supernatural entities.